ABRAMED PANEL - ENGLISH VERSION

149 The service provided by associates is mainly concentrated in >> the state capitals, which on average account for about 60.3% of the calls, while 39.7% are concentrated in the countryside. It is noteworthy that some associates offer services in both capitals and countryside. Gráfico 41 Participation by service area by capital and countryside (2018). 66.7% 54.5. % 61.9% Source: Abramed Panel. Abramed Elaboration. 33.3% 38.1% 45.5. % 75.0% 58.3% 41.7% 25.0% Service to Service to Private Providing support Service to private hospitals public hospitals Market Service to other the dental segment laboratories Capital Countryside Abramed associates continually invest in quality management >> and had on average 4 certifications or accreditations per company. In 2018, the most widely used accreditations in the diagnostic medicine segment were: ONA (National Accreditation Organization), PALC (Clinical Laboratory Accreditation Program), PADI (Imaging Diagnostic Accreditation Program) and ISO 9000/9001.

150 6ABRAMED ABRAMED PANEL PANEL “In 2018, the associates had on average 4 certifications or accreditations. ” Graph 42 Participation by type of certification or accreditation in 2018. Source: Abramed Panel. Abramed Elaboration. ISO 29.4% 47.1% 29.4% 52.9%PALC PADI 23.5% 29.4% DICQ ONA Joint Commission

151 The results achieved through scientific production can be >> shared in a variety of formats, such as books and articles in scientific journals or through presentations at congresses. The scientific production was also highlighted in the associates in the last year. In the period, more than 718 indexed articles were produced in magazines and periodicals, 250 papers presented in international congresses and 427 in national ones. Graph 43 Scientific production by Abramed’s associates (2016/2018) Book authoring and/or national or 17 Source: Abramed Panel. Abramed Elaboration. international book chapters 59 718 29 638 490 Publications indexed in magazines and periodicals 427 437 Papers presented at 250 431 INTERNATIONAL congresses 237 203 Papers presented at NATIONAL congresses 2016 2017 2018 Abramed associates invest in the development of new >> business models, especially in startups that offer products for the healthcare market. It is noted that 75.0% of companies participate in new business models capable of assisting in diagnostic management (internal controls and operating procedures) and 45% in developing smartphone applications.

152 6ABRAMED ABRAMED PANEL PANEL “100% of Abramed’s associates use laboratory information systems, electronic medical records and image archiving. ” Graph 44 Source: Abramed Panel. Abramed Elaboration. Participation in new business models (2018) 75.0% 43.8% 37.5% 12.5% 31.3% 25.0% 18.8% Fertilization App Diagnostic Health Therapeutic Diagnostic Startup except Area Development Management management Procedures Startup on diagnosis

153 Graph 45 Management software and systems (2018) SAP Source: Abramed Panel. Abramed Elaboration. (data processing systems, applications, and products) 50% 87% ERP (Enterprise Resource Plannign) 81% 100% LIS or RIS integrated with hospital 93% information system (HIS) 100% LIS 87% (Laboratory Information System) RIS (Radiology Information System) PACS (Picturing Archiving Communication System) Attendance Systems 0% 25% 50% 75% 100% Graph 46 Softwares in apps (2018) Source: Abramed Panel. Abramed Elaboration. Vaccine tracking application 29.4% 70.6% Exam Scheduling App 58.8% 41.2% Reporting application 70.6% 29.4% Use Does not use

154 6ABRAMED ABRAMED PANEL PANEL In 2018, Abramed’s associates had 1,430 collection points, >> whose exams were interpreted in 92 execution centers. In the same year, they presented 248 laboratories in hospitals and 457 imaging centers. Graph 47 Source: Abramed Panel. Abramed Elaboration. Laboratory execution centers 25 29 23 33 37 31 333 13 12 12 Southeast South 11 88 North Northeast 2017 2018 Midwest 2016 Graph 48 Collection stations 699 725 Source: Abramed Panel. Abramed Elaboration. 675 213 218 221 193 201 232 243 254 117 20 29 29 Northeast Southeast South Midwest North 2016 2017 2018

155 Graph 49 Imaging centers Source: Abramed Panel. Abramed Elaboration. 373 337 286 9 12 10 36 39 42 Southeast 10 11 12 17 21 20 North Northeast 2017 South Midwest 2016 2018 Graph 50 Source: Abramed Panel. Abramed Elaboration. Laboratories providing services in hospitals 167 172 175 000 42 37 33 Southeast 19 24 27 10 11 13 North Northeast 2017 South Midwest 2016 2018

156 6ABRAMED ABRAMED PANEL PANEL “Systematic reduction in the number of analog X-rays, which has been gradually replaced by more modern and accurate digital X-ray equipment in the diagnostic process. ”

157 Associated companies58 totaled 3,544 devices in 2018. Of >> note is the negative variation in analog X-ray equipment, which has been gradually replaced by more modern and accurate digital X-ray equipment in the diagnostic process. This is a simple example in which technological, non- substitutive incorporation tends to reduce treatment costs through examination accuracy and reducing incorrect indications to patients. Graph 51 Number of equipments Source: Abramed Panel. Abramed Elaboration. Total 268 3,544 Bone densitometry 82 3,329 31 3,056 Gamma camera 3000 3500 4000 PET/CT Ultrasound 467 1,872 Magnetic resonance 236 2000 2500 91 CT scanner 159 Digital x-ray Analog X-ray 338 Mammograph 0 500 1000 1500 2016 2017 2018 58 It takes into account the associates who answered the question. For this reason, the number may differ from the one reported on the last Abramed Panel Edition.

158 6ABRAMED ABRAMED PANEL PANEL Human resources Abramed’s associates directly employ around Regarding the pace of hiring of the sector, even in face 56,000 employees in the technical, administrative of the retraction of the labor market, the data show and corporate areas. This contingent is present in that in 2017 and 2018 the employment balance was the main regions of the national territory and works positive in Abramed’s associates and the number collaboratively to offer excellent services to patients. of hires exceeded that of layoffs, after the negative The diagnostic medicine market, by its origin, is a result in 2016. There is also a tendency to reduce the segment that needs multidisciplinarity. It is a labor participation of indirectly hired employees. intensive industry and requires professionals with several specializations. Consequently, it contributes >> not only to patient care, but also to the formation of leaders for the health market in several related areas (hospitals, healthcare providers, universities and technical training centers). Graph 52 Source: Abramed Panel. Abramed Elaboration. Number of hires and lay-off +1.3 thousand -1.8 thousand +2.6 thousand 2016 2017 2018 Hires Lay-off

159 Graph 53 Share of indirect employment in total employment Source: Abramed Panel. Abramed Elaboration. 7.1% 6.8% 5.8% 2016 2017 2018

160 6ABRAMED ABRAMED PANEL PANEL Table 25 Human resources participation by type of activity performed Source: Abramed Panel. Abramed Elaboration. Activity 2016 2017 2018 Administrative (total) 26.1% 26.4% 24.8% Administrative (call center) Administrative (Reception) 6.3% 5.1% 6.6% Other administrative 11.4% 11.7% 12.5% Physicians 16.3% 17.1% 14.9% Nursing (higher level) Nursing technicians 2.5% 2.6% 2.5% Nursing assistants 2.7% 2.7% 2.6% Pharmacists 14.3% 14.3% 14.8% Imaging / X-ray Technicians 2.3% 2.0% 2.1% Biomedical doctor working with imaging exams 0.3% 0.3% 0.3% Biomedical, biologist or pharmacist 3.2% 2.9% 3.6% Clinical pathology technicians 1.0% 0.9% 1.0% Hospitality 3.3% 3.5% 3.4% Revenues 4.4% 4.3% 3.7% Other technical level 0.2% 0.2% 0.3% Other higher level 0.5% 0.8% 0.7% 1.8% 1.9% 2.1% 3.3% 3.2% 4.1%

161 Graph 54 Share of human resources by type of activity performed in 2018 (%) Source: Abramed Panel. Abramed Elaboration. Other higher level 5% 10% 15% 20% 25% Other technical levelo Revenues Hospitality Clinical pathology technicians Biomedical, biologist or pharmacist Biomedical doctor working with imaging exams Imaging / X-ray Technicians Pharmacists Nursing assistants Nursing technicians Nursing (higher level) Physicians Other administrative Administrative (Reception) Administrative (call center) Administrative (total) 0%

162 6ABRAMED ABRAMED PANEL PANEL In 2018, Abramed’s associates employed 7,920 >> physicians, mainly in the area of diagnostic imaging, which represents about 88.5% of the links. The expansion of the number of physicians is associated with the incorporation of new associates and alteration in the business segment, with clinical analysis laboratories that now offer the diagnostic imaging service. The main hiring regime adopted for hiring doctors was through the constitution of the legal entity, which corresponds to 94.8% of the total. Graph 55 Number of physicians by specialty (2018) Source: Abramed Panel. Abramed Elaboration. 8,000 7,304 7,603 7,920 7,000 6,000 6,570 6,820 7,017 5,000 4,000 239 273 363 2,778 283 397 218 227 343 3,000 2,000 1,000 0 Imaging Clinical Endoscopy Pathologic Total Diagnosis analysis and anatomy 2016 colonoscopy 2017 2018

163 Regarding the form of remuneration, the main >> models used are the fixed payment and payment by productivity. However, there is a reduction in the participation of this model that follows the trend of changing forms of remuneration. Abramed’s associates follow the reviews and join new payment models to build on the sustainability of the industry. Graph 56 Fonte: Painel Abramed. Elaboração Abramed. Remuneration model – Physicians 50.1% 51.6% 48% 25.4% 25.7% 28.8% 23% 24.2% 23.2% 2016 2017 2018 Fixed payment Payment by productivity Fixed + Variable (Productivity)

164 6ABRAMED ABRAMED PANEL PANEL Graph 57 Distribution of physicians by specialty (2018) Source: Abramed Panel. Abramed Elaboration. Imaging Others Diagnosis 10.8% 70.8% Clinical 1.0patholo%gy Pathologic anatomy 11.1% Endoscopy and 2.6colono%scopy Clinical 3.7analysis%

165 Graph 58 Physician distribution by contracting regime (2018) Source: Abramed Panel. Abramed Elaboration. 4.2CLT % Cooperated 1.0% Legal 94.8person %

166 6ABRAMED ABRAMED PANEL PANEL The number of x-ray technicians decreased by 4.7% >> and maintained the downward trend observed last year. Regarding the contracting regime, it registered 100% of hiring through the consolidation of labor laws (CLT), contributing to the increase of formalization of labor relations. Graph 59 Number of x-ray technicians 2,551 2,424 Source: Abramed Panel. Abramed Elaboration. 2,311 2016 2017 2018

167 Graph 60 Source: Abramed Panel. Abramed Elaboration. Physicians with specialty title (%) 89 88 87 2016 2017 2018 Physicians with specialty title (%) <

168 6ABRAMED ABRAMED PANEL PANEL Care Production In 2018, Abramed’s associates were responsible for positive health outcome, as the clinical decision will >> performing 480 million diagnostic tests, representing be adapted to a correct understanding of his or her 55.8% of the total performed in the supplementary state of health. In addition, the objective of collecting health market. The process of diagnosis has information in the diagnostic process is to minimize important implications for the patient care cycle. When uncertainty about optimal decisions to indicate a a diagnostic test is done in a timely and accurate treatment. manner, the patient has the best opportunity for a Graph 61 Number of tests performed by specialty (values per thousand) Source: Abramed Panel. Abramed Elaboration. Note: Logarithmic scale chart - base 10. Total 480,831 Million Clinical analysis 433,413 Imaging Diagnosis 397,140 Pathologic anatomy 456,367 Million Graphical methods 411,871 378,073 Genetics Teleradiology 18,331 Million Endoscopic Methods 16,353 Nuclear medicine 14,323 3,988 Million 1 3,317 3,287 681 Thousand 652 486 517 Thousand 421 355 413 Thousand 248 126 398 Thousand 377 351 137 Thousand 175 139 10 100 1,000 10,000 100,000 1,000,000 2016 2017 2018

169 Graph 62 Number of tests performed on supplementary health, Abramed and market share (values in million) Source: Abramed Panel. Abramed Elaboration. 1000 100% 900 90% 800 80% Number of exams Market share - Abramed 700 53.1% 55.8% 70% 600 60% 50% 500 49.8% 400 40% 300 30% 200 20% 100 796.8 397.1 816.9 433.5 861.5 480.8 10% 0 0% 2016 2017 2018 Supplementary health Abramed Market share Abramed

170 6ABRAMED ABRAMED PANEL PANEL The number of patients attended reached more than 50 million >> with Abramed’s associates in 2018. As in the previous year, women correspond to the highest percentage of attendances, 62.0%. The service to men represented 38.0% of the total in the same period. It is known that the female public shows greater concern for health and performs more preventive examinations than men. Graph 63 Distribution of care according to patient gender – 2018 Source: Abramed Panel. Abramed Elaboration. 62Women % 38Men % From January 2018, the new mandatory minimum health insurance coverage established by the ANS came into force. The list of health procedures and events established the coverage of 10 new diagnostic tests. It is interesting to note that the incorporation of the new exams corresponds to 0.005% of the total exams performed by the associates in the period. The inclusion of the new exams is in accordance with the recommendations of CONITEC, which provide information about the scientific evidence, efficiency, accuracy, effectiveness and safety of the technology, as well as the comparative economic evaluation of the benefits and costs in relation to already existing technologies. >> 59 National Comission of Technology Incorporation at SUS

171 Graph 64 Number of tests performed that were incorporated into the ANS LIST (2018) Source: Abramed Panel. Abramed Elaboration. Herpes Virus 1 and 2 detection / typing in CSF 1,559 9,388 Kappa / Lambda free light chains, dosage, blood 3,492 Represent 0.005% Aspergillus Galactomanan antigens 1,284 of the total exams Toxoplasmosis - Amniotic fluids 960 creening by PCR (with DUT): 885 taken in 2018 Magnetic resonance imaging (MRI) CSF flow (with DUT) 2,293 Utrasonic Liver Elastography (with DUT) 1,778 199 Aquaporin 4 (Aqp4) - Research and/or Dosage (with DUT) 158 Lower limb arterial angiography (with DUT)) Lower limb arterial MR angiography (with DUT) ALK - Mutation Research (with DUT)

172 6ABRAMED ABRAMED PANEL PANEL “The rate of no-show of patients with previously scheduled procedures increased from 14.0% in 2017 to 14.9% in 2018. ”

173 The no-show rate for patients with previously the participation of the patient in the cycle of medical >> scheduled procedures showed a slight increase, from care is essential, avoiding waste and increased health 14.0% in 2017 to 14.9% in 2018. expenses, as well as monitoring those responsible The no-show can significantly increase the exams for the administration of resources and contracting costs for providers of diagnostic medicine services companies for health plans and insurance. since the allocation of resources is planned considering the demand of the services. In this sense, Graph 65 No show – no-attendance rate on diagnostic imaging exams Source: Abramed Panel. Abramed Elaboration. 16.6 % 14.0 % 14.9 % 2016 2017 2018 Graph 66 No show – rate of absence in procedures by type of exam Source: Abramed Panel. Abramed Elaboration. 29.6%21.6% 16.1%16.9%16.7% 17.2% 19.8% 13.1% 11.7% 12.6%13.4% 10.5% 13.0%14.1%12.4% 11.2% 7.2% 7.7% Bone Echocardiogram Mammography X-ray Magnetic Tomography densitometry resonance 2016 2017 2018

174 6ABRAMED ABRAMED PANEL PANEL The number of test results accessed by the internet “83.4 million totaled 83.4 million in 2018, representing 17.5% of the total. It is an easier and more convenient way exams accessed to access results. Additionally, it avoids the printing over the internet, of films and papers, contributing to the reduction of representing waste and sustainability of the environment. 17.5% of the total. ” >> Graph 67 Number of reports accessed through the internet (values per 1,000) Source: Abramed Panel. Abramed Elaboration. Note: Logarithmic scale chart - base 10. 100,000 74,025 80,852 10,000 81,337 Million 1,216 1,000 1,407 1,727 Million 100 134 157 10 180 Thousand 99 107 127 Thousand 24 26 27 Thousand 10 10 11 Thousand 1 1 2 Thousand 1 Imaging Pathologic Graphical Endoscopic Nuclear Genetics Clinical Diagnosis anatomy methods Methods medicine analysis 2016 2017 2018

175 The number of reports not accessed or withdrawn totaled 15.9 million with >> Abramed’s associates in 2018. This amount represents about 4.0% of the total imaging and clinical analysis performed in the period. Despite the scarcity of scientific evidence, some studies indicate that the proportion of tests not accessed or withdrawn is 5.4%60 and is much lower than that reported by actors working in the health market. Regarding this result, it is important to highlight that the percentage over the total performed showed stability in recent years and it is estimated that this result become smaller each year due to the advancement of access technologies and monitoring of exams. Graph 68 Number of reports not accessed or withdrawn (thousands) Source: Abramed Panel. Abramed Elaboration. 13,6 15,9 12,3 11,5 14,4 13,3 1,8 2,1 2,3 Image Clinical analysis Total 2018 2016 2017 60 Results of Laboratory Tests not Accessed in Brazilian Private Laboratories

176 6ABRAMED ABRAMED PANEL “The percentage of exams PANEL not accessed is directly related to the place of care. ”

177 According to a study conducted from 2012 to 2014 at HCFMRP-USP61, the 10 >> most performed and not accessed exams in seventeen laboratories, requested by wards, outpatient clinics and intensive care units, were evaluated. The results indicate that the percentage of non-accessed exams is directly related to the place of care, being lower in the intensive care unit and higher in the outpatient clinic. In the latter, the percentage of exams not accessed was 6.3% on average in 2014. Table 26 Percentage of exams not accessed 10 most performed exams by location Source: Abramed Panel. Abramed Elaboration. Exams Intensive therapy Wards Ambulatory 2012 2013 2014 2012 2013 2014 2012 2013 2014 Bilirubins 0.43 0.90 0.19 0.66 0.78 0.58 1.02 1.07 1.07 1.98 1.94 5.16 Creatinine 1.74 0.34 0.25 1.69 1.72 1.77 3.37 3.08 5.71 Alkaline phosphatase 1.74 0.34 0.25 1.38 0.53 0.10 1.53 1.71 1.68 2.92 2.93 7.26 Blood glucose 1.44 1.06 0.58 2.43 2.27 2.08 4.64 4.04 7.08 1.42 1.36 1.04 3.03 2.37 3.50 Complete blood count 0.44 0.41 0.53 2.08 2.24 2.32 4.15 3.82 7.42 1.26 0.50 0.92 Sodium and Potassium 0.69 0.62 0.34 1.34 1.52 1.69 3.51 3.09 7.08 TGO / AST 0.73 0.89 0.55 1.56 1.94 1.77 3.62 3.22 7.04 oxalacetic glutamic transaminase 1.93 2.05 1.65 3.39 4.39 5.83 TGP / ALT 1.83 1.85 2.13 3.85 3.50 6.86 alanine aminotransferase TP (prothrombin time) Ureia 61 University of Ribeirão Preto School of Medicine Hospital das Clínicas - USP

178 6ABRAMED ABRAMED PANEL PANEL Service Evaluation The evaluation of patients using diagnostic medicine degree of customer satisfaction and indicates that >> services is performed using the Net Promoter they will continue to consume and recommend the Score (NPS). This is a metric designed to measure service used. for other people. On the other hand, customer satisfaction and loyalty with a company or the rate of negative manifestations increased slightly brand. Among the Abramed associates, there is an between 2017 and 2018. improvement in the indicator each year, from 76.5 in 2016 to 82.9 in 2018. This result indicates a high Graph 69 Level of customer satisfaction Net Promoter Score (NPS) and negative manifestations (%) Source: Abramed Panel. Abramed Elaboration. 4.5 3.8 3.5 76.5 80.9 82.9 2016 2017 2018 NPS Negative manifestations

179 “Quality of care in the treatment relies on the diagnosis of high value, with precision and accuracy in Good practices in diagnostic medicine permeate the generation of patients’ lives at every stage, from healthy moments to complex illnesses. The quality of care in the treatment relies on the diagnosis of high value, with subsidies that helpprecision and accuracy in the generation of subsidies in decision making.that help in decision making. Abramed associates work with processes and protocols that significantly contribute to patient safety. >> ” Graph 70 Compliance rate 10.8 % Source: Abramed Panel. Abramed Elaboration. 8.1 % 6.4 % 2016 2017 2018 Compliance rate ( % )

180 6ABRAMED ABRAMED PANEL PANEL “Overall, supplier assessment shows a gradual improvement and can be rated as satisfactory. ” Graph 71 Source: Abramed Panel. Abramed Elaboration. Percentage of companies performing 502017 % satisfaction survey with doctors 602016 % 602018 %

181 Quality system certification standards generally require >> periodic supplier evaluation. Without the availability of inputs and other necessary materials within their expected deadlines and with a minimum level of quality, it is virtually impossible for a laboratory to be able to provide quality and appropriate services. In this sense, this publication presents indicators about the evaluation of suppliers: cleaning and maintenance services, among others. Overall, supplier evaluation shows a gradual improvement and can be rated as satisfactory. Graph 72 Source: Abramed Panel. Abramed Elaboration. Supplier Evaluation Input Suppliers Maintenance Imaging of laboratory Equipment 10 equipment Maintenance 9 8 7 6 5 4 3 2 1 0 Hygiene and cleaning services 2016 2017 2018

182 6ABRAMED ABRAMED PANEL PANEL “The evaluation of paying sources < through selected indicators presents regular results. ” The evaluation of indicators selected from the paying sources presents regular results, with a worsening in the evaluation of the termination or contract renewal processes. On the other hand, there is an improvement in the exchange of information on care production and on the criteria for adjusting contracts. Graph 73 Assessment of paying sources 10 Termination or renewal Source: Abramed Panel. Abramed Elaboration. 9 8 Readjustment Criteria 7 6 5 4 3 2 1 0 Information exchange of the care population 2016 2017 2018

183 Economic and Financial Performance The consolidated gross revenue of the diagnostic in the same period. Considering the set of companies >> medicine market, considering only the amount associated with Abramed, gross revenues were informed by ANS, corresponds to approximately approximately R$7.3 to R$9.6 in 2018. About 26.7% R$ 33.6 billion in 2018, an increase of 11.6% had gross revenues between R$5 and R$2 billion compared to 201762. In addition, the figures and 66.7%63 with revenues of up to R$1 billion in presented in SUS for the cost of diagnostic 2015. procedures totaled between R$7.5 and R$9.0 billion Graph 74 Billing by value range - Abramed’s associates (2018) Source: Abramed Panel. Abramed Elaboration. 26.7%> 2,000 ≤ 5,000 Até 10 > 1,000 ≤ 2,000 20% 6.7% > 10 ≤ 20 >250 ≤ 500 6.7% 6.7% > 20 ≤ 50 20% > 100 ≤ 250 13.3% 62 Care expenses informed by the operators to ANS via SIP. 63 Ministry of Health - SUS Outpatient Information System (SIA/SUS)

184 6ABRAMED ABRAMED PANEL PANEL Graph 75 Billing by Value Range (2018) Source: Abramed Panel. Abramed Elaboration. 66.7% 33.3% Up to 1 billion More than 1 billion

185 Healthcare plan operators and insurers are the primary source of revenue in the diagnostic medicine market, with 80.4% of industry revenues on average over the past 3 years. Payments made directly by individuals or families correspond to about 13.7% in the same period, while the public system contributes about 5.9% per year. Other sources represent >> less than 1%. Graph 76 6.1% Source: Abramed Panel. Abramed Elaboration. 13.3% Revenue Sources 5.9% 5.6% 13.5% 13.8% 80.6% 80.3% 80.4% 2016 2017 2018 Health insurance Private Public

186 6ABRAMED ABRAMED PANEL PANEL In 2018, the associates of Abramed observed a “Diversification >> diversification in the use of remuneration models with the migration of the Fee for service (FFS) in payment model to other forms. The health market has models focused sought sustainability in many ways, and it is of on health market utmost importance to maintain patient quality sustainability. and safety at the center of care. The main compensation model practiced by the associates ” is the payment per procedure performed (FFS), which represents 82.4% of the total. Graph 77 Payment models used (2018) Source: Abramed Panel. Abramed Elaboration. Fee for service Global budget 82.4% 17.6% P4P - 5.9Pay for%performance Bundle payment 11.8% Capitation 11.8% DRG - Diagnosis 5.9related%groups

187 In 2018, the amount of financial resources allocated >> to the purchase of capital goods reached, on average, about 12% of Abramed’s associated gross revenue. Among the investments made last year, the largest portion was concentrated on the renewal of imaging and diagnostic machines and equipment, infrastructure projects, expansion and improvement of the service units. Graph 78 Source: Abramed Panel. Abramed Elaboration. Investment in capital goods 12.1 (% Capex) 9.1 8.6 2016 2017 2018

188 6ABRAMED ABRAMED PANEL PANEL There is also a high share of investments in new >> information and communication technologies with a view to improving the interoperability of systems in particular. Graph 79 Distribution of investment Source: Abramed Panel. Abramed Elaboration. 21.3% Information and Communication Technologies 44.7% 29.8% 2.2% S1t.a9ff% Machines and Real estate Certifications Qualifications equipment and renovations and Accreditations

189 “About 58.5% of Gross Revenue goes to Medical Services. ” Graph 80 Cost Distribution Source: Abramed Panel. Abramed Elaboration. 60% 59.5% 58.9% 58.5% 50% 40% 30% 20% 14.4% 14.3% 14.3% 10% 11.2% 11.2% 11.1% 5.8% 5.8% 6.3% 0% Direct material Rent, occupation Medical Staff & Services and exam services and utilities Depreciation and intermediation amortization 2016 2017 2018

190 6ABRAMED ABRAMED PANEL PANEL “The average collection period may reach up to 100 days on certain health insurance modalities. The average collection period according to the type of operator was 59.2 days in Self- Management, 54.7 days in Insurers, 50.2 ”in Medical Cooperatives, 49.9 in Philanthropies and 46.8 in Medical Groups. It should be noted that all modalities have shown an upward tendency in >> the average collection period, except for Self-Management. Graph 81 Average collection period according to operator modality Source: Abramed Panel. Abramed Elaboration. 57.6 60.1 59.2 53.4 53.1 54.7 50.2 49.9 43.4 45.5 46.8 44.9 45.3 44.6 45.9 Self-management Medical cooperative Philanthropy Medical group Health Insurance Company 2016 2017 2018

191 Table 27 Average collection period of events by modality considering the 10 largest deadlines (2018) Source: Document of periodic information from health care plan operators – DIOPS/ANS – Extracted in 6/11/19. Abramed Elaboration. Operator Self- Philanthropy Medical Group Health management cooperative Medicine Insurance 1ª Company 2ª 98.5 3ª 91.1 83.7 80.9 100.6 50.4 4ª 76.0 79.7 70.5 98.8 49.9 5ª 68.4 79.3 69.7 92.0 30.8 6ª 68.2 73.2 64.6 89.3 29.5 7ª 66.6 61.3 60.0 84.5 28.2 8ª 66.4 56.9 56.2 83.0 26.5 9ª 63.9 54.1 55.8 73.4 24.9 10ª 63.7 50.0 54.1 71.3 18.9 63.6 46.0 53.9 71.2 44.6 51.9 64.0 n.d n.d NOTE Considers only operators with payment terms longer than 10 days and less than 100 days. Graph 82 Average collection period after improper disallowance, by operator modality (2018) Source: Abramed Panel. Abramed Elaboration. 85 92 67 76 53 Self-management Medical cooperative Philanthropy Medical group Health Insurance Company

192 6ABRAMED ABRAMED PANEL PANEL “Disallowance index of >> 3.9% in 2018. ”The average percentage of disallowance from Abramed’s associates was 3.9% of gross revenue in 2018. The disallow represents the laboratory and imaging tests that were performed and were not paid by operators. Of course, in the group of associated companies, some had an index higher than 4%, according to the type of operator. Graph 83 Source: Abramed Panel. Abramed Elaboration. Disallowance index 3.7 3.9 (monthly average -%) 2.8 3.2 3.1 2.6 2016 2017 2018 % of gross revenue % of net revenue

193 Graph 84 Disallowance rate by health insurance modality (2018) (monthly average - %) Source: Abramed Panel. Abramed Elaboration. 3.5 3.9 2.1 2.4 2.0 Self-management Medical cooperative Philanthropy Medical group Health Insurance Company <

194 6ABRAMED ABRAMED PANEL PANEL Corporate governance Abramed recognizes the need and relevance of the corporate governance process in the risk >> management and internal controls of associated companies. For this reason, from this edition onwards, it presents a set of selected indicators that, in future editions, will certainly have greater coverage. In the corporate governance process, larger groups and companies have already consolidated structures, while smaller companies work to develop a set of indicators capable of measuring some corporate governance requirements, continuously adapting and improving their internal structures and processes. Good corporate governance practices are known to be of great importance for strengthening the management and delivery of quality services, and especially in corporate sustainability. It is noteworthy that the implementation of governance requirements should at no time be associated with increased expenses and the creation of bureaucratic structures. Instead, it should set policies, standards and maintain them at all hierarchical levels of companies with quality of information and transparency. Graph 85 Percentage of laboratories that have controls by level of process evaluation (2018) Source: Abramed Panel. Abramed Elaboration. 61.1% 44.4% 50% 33.3% 27.8% 22.2% 22.2% 5.6% 5.6% 5.6% 5.6% 5.6% 5.6% 5.6% 0% Does not perform Regular Good Optimum Excellent Ensure compliance with rules and laws Ensure the reliability of accounting records Ensure operational efficiency and electivity

195 In general, Abramed’s associates present practices that >> are formally documented and systematically performed, with standardized and recorded routines, which characterizes the process execution as excellent. About 70% of the associated companies have an exclusive channel for their employees to express their opinions and more than 55% have a disclosure and transparency policy for their information. Graph 86 Percentage of laboratories that have standardized routines recorded in manuals according to the level of process evaluation (2018) Source: Abramed Panel. Abramed Elaboration. Does not perform 17.6% Excellent Good 47.1% 23.5% Optimum 11.8%

196 6ABRAMED ABRAMED PANEL PANEL Graph 87 Percentage of laboratories that have a policy of disclosure and transparency of their information according to the level of process evaluation (2018) Source: Abramed Panel. Abramed Elaboration. Does not perform 16.7% Regular 16.7% Excellent Optimum Good 44.4% 11.1% 11.1%

197 Graph 88 Percentage of laboratories that have a sector responsible for internal audit (2018) Source: Abramed Panel. Abramed Elaboration. . 58.8% 17.6% 11.8% Excellent Good Does not perform 11.8% Optimum

198 6ABRAMED ABRAMED PANEL PANEL Graph 89 Percentage of laboratories that have an exclusive channel for the manifestation of their collaborators (2018) Source: Abramed Panel. Abramed Elaboration. 70.6Yes % No % 29.4